(A) Timing and criteria for intervention.
Fracture casualties with stable vital signs after orthopedic treatment, good internal/external fixation, no signs of active bleeding and severe wound infection, but with limb dysfunction can undergo rehabilitation.
(II) Treatment principles and methods.
1. Acute instability period.
Refers to 4 weeks after injury or surgery. The focus of rehabilitation treatment during this period is to stop pain and bleeding, promote the absorption of inflammatory exudate and reduce swelling; carry out exercise therapy for uninvolved joints and healthy limbs to promote blood circulation and prevent muscle atrophy and joint adhesions.
(1) Isometric contraction training of the muscles of the joints adjacent to the fracture without pain in the affected limb, such as isometric contraction of the quadriceps muscle after femur fracture and tibia fracture. Active and passive activities of non-fixed joints should be implemented 1-2 times a day, and the range of activities should be as normal as possible, and normal movements of the healthy limb can be done as much as possible.
(2) With good fracture fixation, the upper limb fracture casualty should be fully weight-bearing down to the ground as early as possible, and the lower limb fracture casualty should start partial weight-bearing down to the ground with the help of orthoses and crutches under the condition of good fracture fixation. Start ADL training.
(3) The injured person should elevate the affected limb when resting in bed and perform abdominal breathing and deep breathing training to prevent crush pneumonia.
2.Acute stabilization period.
Refers to about 4-12 weeks after the injury or surgery. The focus of rehabilitation treatment during this period is to promote the growth and hardening of bone scabs, and to strengthen muscle strength and joint mobility training without affecting the stability of the fracture, to enhance muscle strength and increase joint mobility.
(1) On the basis of increasing the frequency and intensity of muscle strength and joint mobility training, upper limb fractures can be trained with the help of a functional bicycle. Lower extremity fracture casualties can start to gradually move with weight with the help of crutches and braces, starting from 10%-20% of the casualty’s body weight, and increasing 5%-10% of the casualty’s body weight every week according to the condition.
(2) According to the situation, ultrasound and audio electric therapy are used to promote fracture healing, scar softening and joint adhesion release.
3.Recovery period.
Generally for about 12 weeks after the injury or surgery. During this period, the fracture is basically healed, and the injured person should increase the intensity of rehabilitation treatment to promote the early and rapid return to normal function of the affected limb.
(1) Increase the frequency and intensity of acute treatment; strengthen the active and passive joint mobility training until the joint mobility returns to normal; continue to carry out progressive weight-bearing activities on the ground with the help of crutches and braces until the single leg can fully stand with weight before abandoning the crutches.
(2) Continue ADL training to gradually restore the self-care, work and movement abilities of the injured person.
(3) Teach the casualty to correctly position and move the affected limb, turn over, transfer the position, and correctly implement gait and hand function training in different stages of treatment, which can effectively reduce the pain of the affected limb and the adverse stimulation of the fracture site by training, prevent fracture displacement, and reduce the occurrence of complications.
(C) Key points of rehabilitation care.
1. Give guidance on body position placement and movement according to the different fracture sites of the casualty. Supervise and guide the casualty to perform simple joint mobility, muscle strength, weight bearing, walking and other training in the ward.
2.Prevent complications, such as secondary injuries (falls, burns, etc.), disuse syndrome, lower limb venous thrombosis, swelling, pain and infection of the affected limb.
3. Do psychological care, family and community rehabilitation nursing guidance.
(D) The matching of auxiliary appliances.
1.Apply functional position orthoses and functional training orthoses according to the injury. Lower limb fractures can be configured with the corresponding parts of the load-free orthosis or fixed orthosis.
2, the presence of limb swelling need to make pressure limb sleeve or pressure clothing, lower limb fractures can choose axillary cane, elbow cane, cane and other walking aids, some of the injured need to use wheelchairs, toilet and bath chair.